Phoenix Residential Society Who we are? ▫ Carole Eaton – Executive Director ▫ Michael F....
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Phoenix Residential Society Who we are? ▫ Carole Eaton – Executive Director ▫ Michael F. Seiferling – Research Assistant The Program ▫ Phoenix Apartment
Phoenix Residential Society Who we are? Carole Eaton Executive
Director Michael F. Seiferling Research Assistant The Program
Phoenix Apartment Living Services (P.A.L.S.)
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Introduction The History Paradigm shift in mental health
services (1990) Journey of critical self-reflection The BACKLASH
Forging ahead into the forest alone
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The Forest
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The NEEDS Assessment Intended to assess the extent to which the
intervention is needed Examines the implication of the
circumstances for the design of the program Defines what services
are needed and how they might be delivered?
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The NEEDS Assessment What is the level of need among the client
groups? What are the staffs needs regarding training? What service
areas come up most frequently?
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The NEEDS Assessment - Clients Used Multnomah Community
Abilities Scale Developed by a group of community workers Widely
used in many formal health settings (primarily community based
settings) Is both... Functional Assessment Clinical tool Outcome
measure Research tool
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Who Is It For?
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MCAS Snapshot
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NEEDS Assessment - Clients MCAS Scores 40 = inpatients 50-60 =
high level of support 60 = lower intensity outpatient care
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Summary of Findings - Clients Two distinct groups appear PALS 1
much higher functioning PALS 2 more emphasis on rehabilitation
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NEEDS Assessment - Staff Staff should be recovery focused What
is staffs knowledge of recovery? What does this mean for the
training of our staff?
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The Recovery Knowledge Inventory 20 questions that group into
four factors Roles and Responsibilities risk-taking,
decision-making, responsibility of clients and staff Non-linearity
of Recovery Process role of the illness and symptom management and
non- linearity of the process
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The Recovery Knowledge Inventory Roles of Peers and
Self-Definition persons activities in defining an identity, moving
beyond the role of a mental patient Expectations regarding recovery
including those most effected by the illness
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NEED Assessment - Staff Reasonable understanding of recovery
Non-linearity of Recovery Expectations regarding recovery Scores
comparable to other Region Focus on Motivational Enhancement
Therapy Rapp and Gorscha Strengths Model
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Program Theory Assessment Involves describing the program
theory in explicit and detailed form Various approaches are then
used to examine how reasonable, feasible, ethical and otherwise
appropriate it is
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Program Theory Assessment Main Theories, treatment modalities
Reality Therapy/Choice Theory Psychiatric Rehabilitation Specific
Program guidelines Best Practices Clinical Competencies Evidence
Based Practices/Guidelines/Standards
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Program Theory Assessment Goals of the Program To assist
individuals with serious and persistent mental illness to live as
independently as possible in the community Promote greater
self-reliance and an enhanced quality of life To build on the
existing strengths of the person, to improve skills and increase
supports.
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Case Management Models 1:10 caseload High outreach 24 hour
accessibility Emphasis on skill training High degree of direct
service provision and frequency of contact Occurs in community SMI
high service users 1:20-30 caseload Moderate outreach No 24 hour
accessibility Emphasis on skills training Moderate degree of direct
service and frequency of contact Mainly occurs in community
SMI
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Evidence based ingredients for CM 1.CM should deliver as much
of the help as possible 2.Natural community resources are primary
partners 3.Work is in the community 4.Individual and team case
management works 5.Case managers have primary responsibility for a
persons services
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Evidence based ingredients for CM 6.Case Managers can be
Para-professionals 7.Case loads should allow for high frequency of
contact 8.CM should be time-unlimited 9.People need access 24-7
10.CM should foster choice
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Caseload size Research does suggest that a caseload of 20:1 -
30:1 ratio may work provided that the people receiving services
are: more stable and independent or the caseloads are compromised
of people normally distributed in terms of severity
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Frequency of Contact It has been stated that the strongest
predictor of successful engagement [is] frequency of contact
Frequency of contact has been identified as more important that
total hours of service, suggesting that brief visits may be more
valuable then less frequent but longer visits
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Frequency of Contact A good average to strive for people who
are typical of involvement with ACT/ICM programs is 11 contacts per
month (2-3 contacts per week) It is suggested that phone contact
may also be used as a supplement to face to face contact The
quality of contact may play a mitigating role on determining client
outcomes. In other words, there must be a strong helping
relationship present in order for any frequency of contact to be
effective
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Time-unlimited service It has been stated that time-unlimited
services are a critical element for evidence based case management
There has been some research which suggests that successful
transfers can be made to lower intensity services The presents of
informal social networks have been considered an important factor
for people moving on
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Program Theory Assessment Other options Fidelity assessments
for EBP Rapp and Goscha Strengths Case-Management SAMHSA Toolkits
for Illness and Symptom Management, IDDT, ACT Quality Review Tools
Rapp and Goscha Strengths Case-Management MET Quality Review
(MISC)
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Program Process Assessment Examines how consistent the services
actually delivered are with the goals of the program If services
are deliver to appropriate recipients Assess the extent to which a
program is implemented as intended and operating up to the
standards established for it
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Program Process Assessment
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Program Process Findings Significant gaps in programming for
community clients (i.e. social, money management and medication
management) Frequency and Quality of contact needed to be adjusted
(higher needs clients were being under served/need for MET) Sharper
focus on how rehabilitation goals were being developed and defined
(i.e. Strengths Model)
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Program Impact Assessment Involves providing an estimate of the
net effects of a program Establishing the status of the program
recipients on relevant outcome measures and also estimating what
their status would have been without the services
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Program Impact Assessment Able to compare our program to other
that have used MCAS This comparison allows early estimation of
program impact Allows for more longer term applications to be
considered
Slide 42
Comparison CMHEI On-going samplePALS Intensive Community
Support Program (ACT/ICM) Several contacts per week Caseloads size
17:1 Age = 43.1 years Schizophrenia = 69.3% Mood Disorder = 28.4%
Range (45-85) Intensive Community Support Program Several contacts
per week Caseload size - 13:1 Age = 45 years Schizophrenia = 80%
Mood/ Anxiety /other = 20% Range (32-80)
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Comparison
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Program Impact Assessment What about Recovery? MCAS measures
functional outcome but not ones sense of recovery Common
misconception that these are directly linked
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Davidson explains
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The Vermont Study
Slide 48
Mental Health Recovery Measure Based on research of the
consumers views of recovery Developed for Adults with SMI who are
receiving services from criminal justice system inpatient settings
outpatient service settings peer-run programs residential settings
Correlations with Empowerment Scale Resilience Scale Community
Living Scale
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MHRM and subscales
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PALS Comparison
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Recovery and Functioning Compared MHRM and MCAS scores Found
no/little correlation in scores MHRH scores hit ceiling so cant be
used for on- going measurement Decided to move toward Strengths
based goal attainment as a recovery measure
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Strengths Perspective
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Implications - Outcomes FunctioningRecovery The Skills one need
to live in the community as independently as possible Includes
symptom management Tends to determine traditional outcomes in
mental health Measured by the MCAS Requires knowledge in PSR
Includes how much personal satisfaction one has in their lives
Speaks more to how a person accommodates/manages the disability Can
occur even with lower functional scores Measured by Goal Attainment
Requires knowledge in MET and Strength Assessment
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Program Impact Assessment
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The Efficiency Assessment Considers the relationship between
the program cost and its effectiveness This builds on good process
and impact assessments One of the most difficult areas
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The Efficiency Assessment
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Clinical Leadership Program
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What we have learnt so far Program Evaluation is not as simple
as identifying an outcome measure Must address infrastructure
issues along the way (i.e. data management, training) Must be seen
as part of a longer term plan Have a plan to deal with
resistance
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Whats ahead Strength's assessment which leads to consistent
goal attainment scaling Managing Data Additional tools Ability to
clearly identify the impact of specific interventions (i.e. peer
support, Social Skills Training)
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Final Thoughts One program at a time! Dont forget to plant all
the trees Forests dont grow in a day!!! Even small scale programs
can start the process of program evaluation Try, try, try
